washington psychiatrist dr. brian doyle. >> >> brave new world, the 20th century novelist albert huxley envisioned a future where everyone was kept happy and tranquil with a drug called soma.

mr. huxley's brave new world is here, from ritalin to paxil to zoloft, people are taking mind-altering drugs in record volumes. not since the '60's have americans popped so many pills. have psycho pharmaceuticals turned us into a zombie nation? or should we just go with the flow and embrace the brave new world of mood control? we'll ask new york magazine journalist ariel levy and washington psychiatrist dr. brian doyle. >> a.d.m. the nature of what's to

come. >> welcome. ariel levy, you authored a cover story for "new york magazine" which we see here "what are you on?" and you described new york today to -- you say sound the alarm, there is a new drug epidemic in town and most of the city wants in on it. in certain circles of new york, it is regular table conversation. we have entered the golden age of self-medication. drugs have become like hair products or cosmetics. this is brain styling, not mind altering, and you have a serious point to make there, but what is the extent of what you see going on in new york? >> well, i mean, i think new york is the same town that brought you woody allen and brought you everybody having a psychiatrist. there not a great deal of stigma to being neurotic in new york. it is accepted to the point of maybe being desirable in certain

circles. i think now that these medications are more common, new york is the place where people are going to be comfortable with it and going to be open about it. >> you make a point of saying here that this is brain styling, not mind altering. you make a clear distinction between the two, do you not? >> yeah. i think people when they have actual problems like anxiety, depression or insomnia. they take these drugs. they become normal. they don't become drugged out. >> but you're differentiating certain kinds of drugs from very serious drugs, and you can speak to this, dr. doyle. >> sure. >> and that, say, schizophrenia. we're not in that category of drugs here, are we? >> it is highly unlikely for people in new york to pop antipsychotics for the fun of it. >> we're not talking about bipolar, are we? >> we end up talking about that, and that's in ariel's article. >> is it a national trend or

just in manhattan? >> i'm sure it is true for washington, but i don't know how true it is representative for the united states. >> let's try a few names here. you have put here on your cover both the condition and the drug that might meet the condition. bumped into ex-girlfriend, viagra. big dinner to organize. ritalin. chewed out by the boss, perk s set. n won't take to toilet training, valium. hate to socialize, have to socialize, paxil. time to kick back, vicodin. is that a gray hair? valium? husband wants some space:pin.

clonopin. >> had too many cocktails. viagra. what else do we have here. i'm reading a few. got seventh parking ticket this month, xanax. got rejection slip from publisher. vicodin. deadline pushed up, ritalin. always a bridesmaid -- zoloft. i'm almost through. i want to read some more of these. i swear this has never happened to me before. viagra. ex is dating a celebrity. paxil. and a few more. so you see what we're talking about here, people just pop these drugs. not only do they pop them, but they trade in them, do they not? >> they do trade them. first of all, i should say we're trying to be amusing. the vast majority of people taking these drugs are taking them because they need them. it is the case that people told

me when i wrote this article that drug dealers who deal street drugs will deal prescription drugs and will straight street drugs like cocaine or heroin for the individual prescription drugs. i would like to point out that the people who told me this, if they're trading their prescription drugs to a drug deal forestreet drugs, they already knew a drug dealer. they're already the sort of person who's dealing in a naughty way with substances, so i don't know the problem is with the drugs. i think in those cases the problem is with the people and they would find a way to make trouble regardless. >> what we're talking about here is recreational use of drugs, not medicinal use of medications. the biggest problem with these medications that they are severely underused in this country, not that they're overused. they are severely underused. >> underused for medications? >> underused for the conditions that they're indicated for. they're underused for depression and the various kinds of anxiety that burdens so many people, so

yes, there may be new yorkers taking these medications for fun, but that's not the way it is for most americans. >> she describes a cocktail party as a pill bazaar where pills are exchanged, correct? >> . yeah. i think a point that comes up with this is that there can be a fine line between medication and recreation. it's not like cancer where you can take a test and either you have it or you don't. there isn't a test to see if you have enough seratonin, which is why somebody would take prozac or another ssri. i mean, it's not as black and white. >> it's not likely you have an x-ray that shows you whether or not you have a major depression, but we do have well set out diagnostic criteria for these conditions and people either meet them or they don't. it's not just that these are set by the american psychiatrists. these diagnostics are criteria around the world. we do have diagnostic criteria

and people either do or do not have certain real problems. >> one of the strong characters in your narrative here is molly small, and molly small says "i don't think there's anything wrong with something something on flights, if you have a plane for me, there's no reason for me to sit there and freak out the whole time when you could take a clonapin and pass out and not deal with it, because what are you going to do about it anyway? all this face your fear baloney, that's so very '80's, and i don't really believe in it, so this is more than recreational uses. this is to relieve, in this illustration, she is relieving fear of flying. >> ariel is talking about both things in her article.>> she is talking about the recreational use of medication, and also talking about entirely appropriate use of medication. a good example is molly small who has clearly been through the

wars, uses her medication and uses it appropriately. i don't have any problems with the molly smalls. >> are we as a society, overly anxious? are we fixated on the dark side of life? have our highest officials pounded into our heads that we are in imminent dangersycho phat is the new drug from saddam hussein and usama bin laden, the terror alert level stays elevated with the two lowest levels blue and green never having been used at all. is all of this pushing up the demand for psycho pharmaceutic pharmaceuticals? we put that question to our guest, but first here are their born, new york city, 29 years of age, single, jewish, democrat, wes leann university, con net cat, ba, english. late night with david letterman, cbs reports researcher, and altogether, six months. new york magazine, intelligencer

intern. editorial assistant. book columnist. features writer. co currently author, working on her first book, female chauvinist pig, simon and schuster, free press. hobbies, cooking, traveling, extreme cooking, gym addict ariel levy, born boston, 62 years of age, wife margaret, three children, democrat, harvard college ba, english. ma gill university, montreal, m.d.. massachusetts mental health center, resident in psychiatrist, three years. u.s. army, pentagon major, two years. faculty appointments, harvard medical sister, assistant professor, four years. george washington medical school, associate medical professor, georgetown medical school psychiatry, 20 years and currently medical answers,medicy television program, host 8 years

and currently. author, 36 articles, four monographs and 204 professional presentations on adult attention deficit disorder, depression, post traumatic stress disorder, psychopharmacology. hobbies, acting, singing, power walking. brian bowls doyle. >> on the words psychopharmacology, you say, ariel, the psycho pharmacologist is the new drug dealer, like a park avenue drug dealer. is that how people look upon psychopharmacology? >> that's what one of my sources said to me. that's how she views it. i think that's how some people -- they've taken their attitude that they would have had once towards street drugs and transferred it on to prescription pills. >> you mean, they were taking marijuana in high school and then graduated to coke in college, and now they're into park avenue drugs, and they have

a psychiatrist so they have a psycho pharmacologist? >> the girl you're speaking of, that's what she said. >> isn't that true in many cases? >> it's true in many cases. i think what's interesting about that particular aspect is one young woman told me she has been taking adderall. she said one time she tried cocaine and it was horrible, a terrible version of the drug she was prescribed. she said why would i ever do coke? it raises the interesting point that in some cases people have been self-medicating for years. they have been taking alcohol to relax, cocaine to jump themselves up, and if these prescription drugs do whatever that job is in a more precise, effective, less dangerous way, i'm not sure that's a bad thing. >> what's the percentage of cases that you see, do you feel that drug usage on the level -- both levels we're talking about, whether they are high powered to

treat schizophrenia, which you are not principally talking about here at all, correct? >> yes. >> even though the drugs you are are talking about do have a limited medicinal effect in getting people through a temporary anxiety period, but we're not talking about clinical depression here. >> we are talking about clinical depression here. >> but there is a depression that is owning to the loss of a child, which is maddening thing. that's not really what you're talking about. you're talking about essentially recreational with some requirement by reason of circumstances, and that could be from the outside or the inside. >> well, some of the cases, some of the people i was talking to, they may use that kind of lingo and adopt a cool and casual attitude, but a lot of these people if you really question them, they are severely depressed. they have had a lifetime of depression, and these medicines have altered the course of their lives. even if they are being light about it, the fact is they have healed major problems with.

this. >> that's a great point. there's a very good thing in this article, which is that these medications really have become far less stigmatized because most everybody in america knows somebody in their family or among their friends who has taken one or another of these medications and their lives are substantially better. >> selective seratonin reuptake inhibitors. ssri. what does that mean? >> what that means that these are medications which particularly impact seratonin in the brain, and basically they boost seratonin levels in the brain, and when that happens, we've seen that mood improves, anxiety and anxiety falls. >> and you prescribe on the basis of that perceived need in seratonin, correct? you can't diagnose physiologically a low level of seratonin, can you? >> well, you actually can. patients have asked me about this, but i tell them i don't think you would want to do it,

because we can do a spinal tap and we can get the spinal fluid level of seratonin and tell whether or not that's low. most people don't want to get a spinal tap to get treated for depression. >> i want to make one thing clear, and that these drugs are are prescribed for a physiological -- correct me if i'm wrong -- deficiency in the brain. is that correct? an imperfection? in the brain? if you had a perfectly functioning brain, you wouldn't need these drugs. >> who has a perfectly functioning brain? >> there are people. there may not be many of them, but there are people who are doing just fine. >> so that really, in itself, eliminates a great deal of the stigma, because you're talking about a physiological deficiency, correct? >> yes, and the good thing that's happened is we know much more about what's going wrong in the brains of people who are depressed and anxious now. >> so people who want to

continue taking their pills, some of them go off the pills. they experience extreme withdrawl and they also go haywire and they go back on the pills, as molly small describes vividly, right? >> yes. >> so the major lesson that i see here is what is different from old school is that we're talking here about physiology, to some extent? >> i think the big lesson here is if you're having symptoms, see a doctor, and take medicine among other treatment options as a doctor recommends. if you take these medicines the way we recommend, you won't get in any trouble from taking them. yes, there are side effects. it's not like they're miraculous, but by and large, if patient dozen as i tell them to, they don't get into trouble. >> what does clonopin do? >> it is the same family of valium, a long-acting version of valium. it is useful for anxiety. it is used for both of those conditions. >> what does ambien do for you?

>> knocks you out and puts you to sleep fast. ambien, correct me if i'm wrong, when it says in the physician's desk reference is no one knows why it works t is mysterious. >> it is not that mysterious. it is not in the valium family structurally, but the way it works is just the way valium and clonopin and other medicines in that group work. >> is it addictive? >> is there a physiological compulsion to continue using the drug that transcends reasons or transcends any medical inclination, physiologic in its come pulcompulsion? >> there are some people who take ambien for long periods of sometime will not be able to sleep without it. >> are there those who try to force the drug in this fashion that they will resist the

sophoric impact and refuse -- >> people use these drugs creatively. people will use ambien and not allow themselves to fall asleep. >> they get into what state of mind? >> hallucinations. some people can't sleep on t it doesn't work for everybody. is there a large black market for these medications? >> i don't know what large mean. there is certainly a black market. >> so there is trading and mixing and matching that goes on among users, correct? >> sure. >> that then is the kick, is it not? >> is it? what's a kick? if you're taking it because you want to relax on an airplane, is that recreational or medicinal? that's why i think there is a fine line sometimes. >> and in the introduction to your bios, i raised the question of whether or not there are societal forces at work, which are due impacts psychologically so there is a need to develop. what comes to mind immediately is 9/11. >> absolutely.

the use of these medications went up across the nation after september 11 and in the months odirectly after september 11, they went up way more in new york city, double the rest of the country in terms of benzodiazepines and sleeping pills an 6 times as much as antidepressants. >> what do you think the rol of external circumstances in inducing needs that are visible because of increasing anxiety? >> i think 9/11 is a perfectly good example. yes, that the use of antidepressants and anti-anxiety agents went up in new york, but what impresses me more is the resilience of the human spirit. millions of new yorkers kept going, didn't get lots of mental health treatment, didn't start taking medications. people by and large are really resilient, and the vulnerable ones who have some external circumstance will get tipped over. >> did you experience patients who might say we are moving in a

cum tour where we have -- culture where we have gwen ten tarantino and his blood-soaked films, ghoulish crime scenes, hannibal lechter, big screens and tv screens, and twin peaks. >> to be honest, those influences are comparatively trivial. the world health organization emphasizes that in the year 2020, untreated depression is going to be the leading cause of impact on quality of life worldwide. this is not the kind -- this is from the world health organization. >> is there anything in the culture, in society that is different from before that is creating an alteration of mental outlook? >> sure. i think that the heightened security in the united states after the terrorist attacks. >> not in the world of entertainment? >> it is them as well as everybody else. >> we have the next generation of psychiatric drugs coming along. what do you see there, dr. brian

doyle? >> i see medications that are going to be at least as effective as the ones we have now, if not more effective, with more favorable side effects. >> have you heard of free gavelin? >> yes. >> what is it? >> it it the first generation of drugs that will affect the inside the brain cells an alter the way they work. that's where the central problems with and that's the hope of the future. >> are we talking genetics here? >> ultimately, we may be, actually. >> because there's reference to that in this new book that i just got by chance, better than prozac, samuel h.barrantes, quite a story there, that they can manipulate genes so as to provide a level of what, sanity, full sanity that the victim had

been deprived of. do you want to make any points on the subject of the future? >> i think it would be exciting to say we are able to invent drugs that can work a longer period of time. the complaint is that people will an srri that works and it will peter out and then they have to find a different one that works. >> it happens in a small minority of patients t doesn't happen often. >> and with benzodiazepines, people have to take more and more. they become less effective. >> that's not true, not for my patients f people are using these medications as they are indicated for medically -- in fact, my patients use of benzodiazepines goes down, because they get less anxious. they start saying i can do this. i don't need all this medicine. so the medicine use goes down. >> the economic implications of this. does insurance pay for the kinds of drugs we have been talking about here? >> yeah. >> they do?

>> uh-huh. >> is that what is driving up the drug costs? >> i think what's interesting is that they will pay for these medicines but they won't usually pay for psychotherapy. i think that is an unfortunate situation that does lead people towards using drugs without getting ad adequate talking car. >> or without going to a proper physician. a proper physician is a psychologist or a psychiatrist, not a general practitioner. >> more psychiatric patients are seen by primary care physicians han will ever be seen by psychologists or psychiatrists. >> absolutely. >> you feel that is dangerous because it could be mis mis-prescriptions? >> doctors are getting better at diagnosing and treating mental illness in the framework of primary care. >> you also have your whore stories about primary physicians who have erred and those

mistakes have been ruinous, is that true? >> yes. but that's the case of any aspect of medicine about any condition. >> why don't they refer in all instances? >> because there are not enough of us. there are a small number of psychiatrists. we are only 7% of american physicians. there aren't many. >> why? >> because not a lot of people go into the specialty. >> don't you discuss that when you have your professional trade association meetings and i say y are our numbers so few? >> i think we're too busy trying to figure out what we can do to help the people we're trying to see. >> do you recruit? >> i've been very involved in medical student education for years. at least indirectly i hope i have been recruiting in psychiatry for a long period of time. >> do you have more to say on why there aren't more recruits? have you thought of going into sigh kapsychiatry yourself? >> no, no. >> where does freud stand today? >> freud is unfashionable. a lot of what he contributed was

enormously useful and continues to be. >> i declared him to be the greatest origil thinker of the century. >> he was an astonishingly original thinker. >> do you have comments on the safety aspects of drug taking? >> i want to point out that the conditions that these drugs eliminate or help with are more dangerous than the drugs. anxiety is really bad for your body. sleeplessness is very bad for your mental and physical health, so these drugs, if they're helping you with these conditions, you're doing yourself a favor. ssri's are non-addictive and you can't overdais. they're fairly safe. >> you prescribe these drugs, right? >> yes. >> you see the addictions, do you not? >> it is something that we call appropriate medical attendance, with somebody taking a medication as prescribed to feel normal, that's not addiction. >> are doctors, psychiatrists overprescribing? >> no. we, in fact, are underprescribing, and there is solid data to support that.

>> when you know that someone is going to slip into a depression -- not into a depression, into an addiction because of the nature of the pharmaceutical that you prescribe, and you know it is enormouslyifficult to get out of the addiction, you are willing to weigh the value of the drug over against the shortcoming of the fact that it's addictive, is that correct? >> that's correct. my patients, i have not had problems with addiction in my patients. >> what do you mean by problems that, they're not addicted? >> that's correct. >> what drugs are addicted, unquestionably addicted? >> any of the benzodiazepines can be. among these medicines, those are about the only ones that are healed major problemsmedicationy and effectively. >> on the same person? >> on the same person. >> thank you so much. i'm sorry we're out of time. ariel levy a washington psychiatrist

dr. brian doyle. >>